EASL Campus

A 45-year-old woman without a specific medical history goes to her GP (general practitioner) for a medical check-up. Body weight: 79 kg, height: 1.67 m, waist circumference: 94 cm, blood pressure: 138/88 mm Hg. She reports sporadic use of alcohol (a glass of white wine occasionally) and has been smoking 12 cigarettes per day for 30 years. Platelet count: 220 × 10⁹/L, ALT: 32 U/L (ULN < 40 U/L), AST: 28 U/L.

Which of the following would be the correct approach?

A. Given the risk factors (overweight, an increased waist circumference and waist-to-height ratio indicative of visceral adiposity, and elevated blood pressures) a referral for a liver stiffness measurement is recommended, along with smoking cessation and anti-hypertensive treatment.

B. Smoking cessation, other lifestyle modifications and anti-hypertensive treatment should be started, along with measuring serum lipids and glycaemic control, with further appropriate management if needed. Liver follow-up is, however, not indicated. If the metabolic risk factors do not sufficiently improve, the FIB4 should be checked again in 2 to 3 years.

C. The patient is not living with obesity; transaminases are normal and FIB4 is low. No further liver assessment is needed but smoking cessation is recommended.

D. Smoking cessation, other lifestyle modifications and anti-hypertensive treatment should be started, along with measuring serum lipids and glycaemic control, with further appropriate management if needed. Liver follow-up is, however, not indicated.

E. Smoking cessation, other lifestyle modifications and anti-hypertensive treatment should be started, along with measuring serum lipids and glycaemic control, with further appropriate management if needed. Liver tests should be repeated after 6 months.

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